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Information & Frequently Asked Questions
Here you will find answers to common questions regarding Parkinson’s, neurological symptoms, and treatment options.
What are the early signs of Parkinson’s disease?
In the past, the onset of the disease was defined by the appearance of motor symptoms such as tremors, slowing of movement, or muscle rigidity. However, neuroscience has made immense progress in recent years, and we now know that the disease begins years, possibly even decades, before motor symptoms appear. At this early (“pre-symptomatic”) stage, an exact diagnosis is not yet reliably possible, but certain symptoms may occur.
Symptoms that can occur in the early phase include:
• Depressive moods and anxiety.
• Pain: A very common early symptom. Frequent misdiagnoses at this stage include “shoulder-arm syndrome,” carpal tunnel syndrome, or muscle tension related to cervical syndrome.
• Constipation: (See FAQ “Nutrition”).
• Sleep disorders: Such as “REM sleep behavior disorder,” a condition involving vivid, intense nightmares and physical movement during dreams.
• Olfactory dysfunction (Hyposmia): An impaired sense of smell can occur many years before the actual onset of the disease. It is very common in Parkinson’s patients; for example, the smell of oregano may no longer be perceived. Consequently, food often loses its flavor and tastes bland, which is a frequent cause of weight loss.
Early motor symptoms may include:
• Changes in facial expression: Reduced emotional expression (“masked face”).
• Speech disorders: Quieter, more monotonous, and slower speech.
• Movement: Parkinson’s often begins on one side of the body. Symptoms include slowing of movement (bradykinesia), stiffness (rigidity), slower walking, less fluid turning, a stooped posture, and reduced arm swing while walking.
• Tremor: Often appears first in one hand as a “resting tremor” (e.g., when hands are resting on the thighs). It is sometimes called a “pill-rolling tremor” due to the specific movement pattern.
• Micrographia: Handwriting becomes smaller, often starting with normal-sized letters at the beginning of a line that shrink toward the end.
What are the causes of the disease?
The exact cause of Parkinson’s disease remains unclear. Current research suggests a complex interaction of multiple factors. It is believed that an unknown external “noxa” (harmful agent) may trigger the disease in individuals who are genetically predisposed. A widely accepted theory is that the process begins in the gut. Changes in the microbiome (bacteria, viruses, fungi) may disrupt the intestinal mucosa, allowing toxic substances to enter the body more easily. Important: Parkinson’s is NOT contagious. In patients younger than 45, genetic causes are frequently identifiable. Pathologically, the disease involves the degeneration of specific nerve cells in the brain, leading to the formation of “Lewy bodies.” The “substantia nigra” (black substance), which is rich in dopamine-producing cells, is particularly affected.
What happens when you have Parkinson’s?
Typical symptoms are movement disorders such as tremors, slowed movements, and muscle stiffness. These changes often start on only one side of the body.
Later in the course of the disease, other symptoms may appear:
• Balance problems and instability.
• “Non-motor” symptoms: sleep disorders, loss of smell, bladder dysfunction (increased urgency), circulatory issues (low blood pressure/dizziness when standing up), apathy, anxiety, and depression.
What is the life expectancy with Parkinson’s?
Life expectancy has greatly improved due to modern therapies. Generally, life expectancy is normal or only minimally reduced by one to two years. The course of the disease varies and depends on other comorbidities. It can be positively influenced by medication, exercise, a balanced diet, and an active lifestyle.
What can people with Parkinson’s do?
While there is no cure, medication can alleviate symptoms and lead to a 60–100% improvement in early to middle stages. Medication remains effective at every stage. Crucial additional therapies include:
• Endurance training and physical therapy (focusing on balance and stretching).
• Speech therapy (Logopedics). • A balanced diet and active lifestyle
Which diet is beneficial for Parkinson’s?
Recent studies show that proper nutrition can favorably influence the course of the disease. Most international guidelines recommend a “Mediterranean diet” (high in fresh vegetables, fruit, fiber, healthy oils like olive or walnut oil, fish, and legumes; low in meat).
• Hydration: Drink at least 1.5 to 2 liters daily (water, tea, coffee, or soup) to prevent constipation and stabilize blood pressure.
• Avoid: Processed foods and excessive sugar.
• Medication Note: If taking Levodopa (e.g., Madopar, Sinemet), do NOT take it with meals. It should be taken at least 30 minutes before or 90 minutes after eating.
Which sports are recommended?
In addition to endurance sports, activities requiring complex movement patterns are highly recommended:
• Climbing (under supervision/in Parkinson’s groups), dancing, Tai Chi, table tennis, boxing, and Nordic walking.
• Regular exercise several times a week is ideal, but ensure adequate rest phases afterward.
What should I keep in mind when taking medication?
In advanced stages, it is vital not to take Levodopa with high-protein meals (meat, dairy, eggs), as protein can block the absorption of the drug in the small intestine, leading to a loss of effect.
• Timing: Take Levodopa at least 30 minutes before or 90 minutes after meals.
• Punctuality: Medication should be taken as punctually as possible.
• Protein Management: While protein is necessary to prevent muscle loss, shifting protein intake primarily to the evening can help reduce motor fluctuations during the day
Does the effect of Parkinson’s therapy decrease after many years?
Levodopa will generally remain effective for motor symptoms at every stage. However, in advanced stages, symptoms may emerge that do not respond well to Levodopa, such as balance problems or cognitive deficits. The goal of therapy is always to achieve the best possible effect with minimal side effects.
Am I allowed to drive with Parkinson’s?
In general, a driver must have no health impairments or a condition that is so well-controlled that symptoms are unlikely to cause problems. Whether you can or may still drive depends on the severity of your movement disorder, potential deficits in concentration and attention, and possible side effects of medication. It is essential to discuss this topic with your treating specialist.